Affected by Aetna’s Payment Changes? File a Complaint with NJ DOBI
NJDA previously provided members with an analysis of Aetna’s changes to payment methods for out-of-network dentists and the protections contained in New Jersey law. Members who would like additional background can read Aetna to End Paper Checks for Out-of-Network Dentists: What New Jersey Dentists Should Know.
NJDA is now encouraging members affected by Aetna’s payment changes to submit a formal complaint to the New Jersey Department of Banking and Insurance (DOBI).
The purpose of the complaint is not for the dentist to determine whether Aetna has violated New Jersey law. Rather, members should document how the policy is affecting their practice and ask DOBI, the state agency responsible for enforcing New Jersey insurance laws, to review Aetna’s implementation.
File Your Complaint
Members may submit an insurance complaint through DOBI’s online Consumer Complaint form.
NJDA has reviewed the DOBI complaint form and prepared the guidance below to help members complete it. Because this is a general consumer insurance complaint form, some fields may not fit neatly with a complaint from an out-of-network dentist regarding a carrier payment policy.
What You Will Need Before Starting the Complaint
Your Information
Have the following available:
First and last name
Practice mailing address
Phone number
Email address
Preferred contact method
The form also asks for county and country information.
Insurance Information
For the insurance section, provide the information that applies to your situation:
Name of insurance company: Aetna
State in which the plan was purchased: if known
How the policy was purchased: if known
Policy number: if applicable and available
Certificate number: if applicable and available
Claim number: if your complaint involves a specific claim
Type of insurance: select Dental
If your complaint concerns Aetna’s overall payment policy rather than one particular patient claim, some of the claim-specific fields may not apply.
The form also contains fields for dates of loss and amount in dispute. Complete those fields only if they accurately apply to your particular complaint.
Reason for Complaint
The DOBI form does not include a specific category for provider payment-method disputes.
For a complaint focused on Aetna’s change in payment methods, “Other” may be the closest available category.
In the “Other Desc” field, you may use wording such as:
Aetna out-of-network dental provider payment policy / elimination of paper checks
Members should select whichever complaint category most accurately reflects their individual circumstances.
Details of Complaint
The form provides up to 4,000 characters for the “Details of Complaint” section.
Your complaint should be factual, specific and based on your own experience.
Consider explaining:
That you are an out-of-network Aetna dentist.
When you received Aetna’s notice.
What the notice stated regarding the elimination of paper checks.
What payment alternatives Aetna made available to your practice.
Whether virtual credit card payments would result in merchant-processing fees.
Whether the notice indicated that contracted dentists may continue receiving checks.
Whether you contacted Aetna regarding your preferred payment method and what response you received.
Any actual processing fees, delays or administrative burdens your practice has experienced.
You may use the following language as a starting point. Please modify it so that it accurately reflects your own experience.
I am an out-of-network dentist practicing in New Jersey. Aetna notified my practice that paper check payments will be discontinued and that providers who do not enroll in electronic funds transfer may receive reimbursement through virtual credit card payments.
The notice I received also indicates that contracted dental providers may continue to select payment by check. As an out-of-network provider, I am concerned that continued access to paper check payments appears to be tied to participation in Aetna’s network.
Virtual credit card payments may result in merchant-processing fees to my practice. The alternative offered to me is enrollment in electronic funds transfer through Aetna’s designated enrollment process.
New Jersey law provides protections regarding payment methods available to out-of-network providers under N.J.S.A. 17B:30-34.1. I understand that the statute does not expressly require a carrier to continue offering paper checks. I am therefore asking the Department of Banking and Insurance to review Aetna’s implementation of this policy and determine whether the payment options, fee disclosures and procedures being provided to New Jersey out-of-network dentists comply with applicable New Jersey law.
I am also concerned that Aetna is making paper check payments available to contracted dentists while eliminating that option for out-of-network dentists.
If you have actually incurred a VCC processing fee, EFT-related charge or another payment-related expense, include the specific amount and retain documentation.
What Do You Consider to Be a Fair Resolution?
DOBI provides a separate field of up to 4,000 characters asking what you consider to be a fair resolution.
You do not need to determine what enforcement action DOBI should take.
A straightforward response may be:
I ask the Department of Banking and Insurance to review Aetna’s payment policy for New Jersey out-of-network dentists, determine whether its implementation complies with N.J.S.A. 17B:30-34.1, and require any corrective action the Department determines appropriate. I also request that Aetna provide out-of-network dentists with meaningful payment choices and clearly disclose any fees associated with those choices.
If your preferred resolution is continued access to payment by paper check, you may say so in this section.
What About Paper EOBs?
If Aetna’s elimination of mailed paper EOBs is creating an additional administrative burden for your practice, you may include that experience in the complaint as well.
Explain specifically how the change affects your office. For example, describe whether staff must manually retrieve individual EOBs from Aetna’s portal, whether your practice has difficulty receiving electronic remittance information through its clearinghouse or practice-management system, or whether the change has increased staff time or administrative costs.
Providing DOBI with specific examples will be more useful than simply stating that electronic EOBs are inconvenient.
Supporting Documents
The DOBI form indicates that after final submission, you will have an opportunity to attach supporting documents.
NJDA recommends attaching, where applicable:
The complete Aetna notice you received
Correspondence with Aetna
Any written response from Aetna regarding your payment preference
Screenshots or enrollment materials showing the available payment methods
Documentation of VCC processing fees or other payment-related costs
Documentation of any problems obtaining payment or remittance information
If you plan to mail supporting documents instead, DOBI instructs complainants to include a copy of the complaint form and send the materials to:
New Jersey Department of Banking and Insurance
Consumer Inquiry and Response Center (CIRC)
P.O. Box 471
Trenton, NJ 08625-0471
Supporting documentation may also be faxed with a copy of the complaint form to 609-777-0508.
Protect Patient Information
The DOBI form states that a copy of the complaint and its attachments may be provided to a party identified in the complaint.
Members should therefore avoid including unnecessary patient or medical information. If information about a particular patient or claim is necessary to explain the issue, provide only what is reasonably needed for DOBI to review the complaint.
Before You Finish
The form asks whether you would like to receive an email confirmation.
NJDA recommends selecting “Yes.”
After submitting the complaint:
Save the submission confirmation.
Retain your DOBI tracking number.
Keep a copy of everything you submitted.
Save any subsequent correspondence from DOBI or Aetna.
Let NJDA Know You Filed
NJDA is asking members who submit a complaint concerning Aetna’s payment policy to let us know by email omorales@njda.org.
If you are comfortable doing so, please provide NJDA with:
Your DOBI tracking number
A copy of the complaint
Any response you subsequently receive from DOBI or Aetna
Individual complaints give DOBI documented examples of how Aetna’s policy is being implemented across New Jersey. They also help NJDA identify patterns and support our continued advocacy on behalf of members.
This information is provided for general educational purposes and does not constitute legal advice. Members should ensure that any complaint accurately reflects their own circumstances.
